NAIROBI, Kenya — Nairobi County official Geoffrey Mosiria has urged President William Ruto to commission an independent assessment of the Social Health Authority (SHA), citing growing concerns over implementation challenges, system failures and alleged irregularities that he says could undermine public confidence in the country’s universal healthcare programme.
In a statement, Mosiria said SHA was introduced with the intention of expanding access to healthcare following the transition from the National Hospital Insurance Fund (NHIF), and that many Kenyans initially welcomed the new system.
However, he argued that problems emerging during implementation require the government to establish what is happening on the ground rather than relying solely on reports from officials responsible for running the programme.
“Mr. President, please do not rely only on reports from officials within the system. Commission an independent, transparent assessment of SHA implementation across the country, particularly in public hospitals and among ordinary citizens who depend on public healthcare,” Mosiria said.
Concerns over cash payments at hospitals
Mosiria said patients have raised concerns about being asked to make cash payments when accessing services they expected to be covered by SHA.
He cited cases involving patients referred from Level 4 facilities to Level 5 or Level 6 hospitals because of serious medical conditions.
According to Mosiria, some patients have allegedly been asked to pay cash before admission despite being registered under SHA, raising questions about whether covered services are being provided in accordance with the programme’s requirements.
He also raised concerns about patients being denied or delayed treatment when the SHA system is unavailable because of technical or administrative problems.
“A system failure should not become a reason for a sick person to be denied urgent medical care,” he said.
Mosiria further alleged that some hospitals could be submitting claims to SHA while simultaneously asking patients to make additional payments for services they believe should be covered.
He stressed that such allegations should be independently investigated rather than treated as established facts.
Calls for investigation into SHA claims
Mosiria also raised concerns over possible fraud and abuse within the SHA claims and payment system, including allegations that individuals associated with questionable NHIF claims could have interests within the new system.
He cautioned that the allegations had not been proven but said they warranted investigation.
“These are serious allegations and should not be treated as facts without evidence. However, they are important enough to warrant an independent investigation,” he said.
He proposed that the assessment establish whether hospitals are demanding cash payments for services covered by SHA and whether facilities are submitting claims to the authority while also charging patients for the same services.
The proposed investigation should also determine how frequently system failures prevent patients from accessing treatment and whether public hospitals receive SHA reimbursements on time.
Mosiria said the government should establish whether reimbursement funds are reaching the services for which they are intended and investigate any fraud, abuse or conflicts of interest within the claims and payment system.
Focus on patients and healthcare workers
Mosiria also called for an examination of why patients referred to higher-level hospitals sometimes encounter difficulties accessing care.
He urged the government to determine whether the experience of ordinary Kenyans differs significantly from that of civil servants or other groups perceived to have easier access to healthcare services.
He said any assessment should involve patients, doctors, nurses, hospital administrators and independent healthcare experts rather than relying exclusively on government officials overseeing SHA implementation.
“Mr. President, please obtain an independent report on what is actually happening in hospitals across the country and correct the mistakes before public confidence in SHA is lost,” Mosiria said.
Mosiria says SHA must work for ordinary Kenyans
The Nairobi official said Kenyans do not want SHA to fail but want the programme to deliver on its promise of accessible healthcare.
He called for accountability if investigations establish that the system is being deliberately undermined, while urging reforms if the problems are found to arise from weaknesses in its design or implementation.
“If SHA is being sabotaged or poorly implemented, those responsible should be identified and held accountable. If the problems are caused by weaknesses in the system, those weaknesses should be corrected,” he said.
Mosiria said the success of universal healthcare should ultimately be measured by the experience of patients seeking treatment rather than by administrative reports.
“The success of universal healthcare should not be determined by reports on paper; it should be measured by whether an ordinary Kenyan can walk into a hospital when sick and receive the care they need without being forced to pay cash because of failures within the system,” he said.
